Thrombolytic Therapy

Acute ischemic stroke patients who arrive at this hospital within 2 hours of time last known well and for whom t-PA was initiated at this hospital within 3 hours of time last known well

Initial Patient Population:

Patients age 18 and older discharged from inpatient care (non-elective admissions) with a principal diagnosis of ischemic or hemorrhagic stroke and a length of stay less than or equal to 120 days

Denominator Statement:

Ischemic stroke patients admitted through the Emergency Department whose time of arrival is within 2 hours (less than or equal to 120 minutes) of the 1) time they were known to be at their baseline state of health; or 2) time of symptom onset if time last known at baseline state is not known

Denominator Exclusions:

None

Numerator Statement:

Acute ischemic stroke patients for whom IV thrombolytic therapy was initiated at this hospital within 3 hours (less than or equal to 180 minutes) of when it was witnessed or reported that the patient was last known to be without the signs and symptoms of the current stroke or at his or her baseline state of health

Numerator Exclusions:

Not Applicable

Denominator Exceptions:

Patients with comfort measures documented on the day of or the day after arrival

Patients with documentation of the very first National Institutes for Health Stroke Scale (NIHSS) score of zero in the emergency department

Patients with Medical Reasons for not initiating IV thrombolytics documented by a physician/APN/PA or pharmacist on the day of or the day after arrival

Patients with any of the following results within 180 minutes of the 1) time they were known to be at their baseline state of health; or 2) time of symptom onset:

Prothrombin Time > 15 seconds

Platelet Count <100,000/mm3

INR>1.7

Partial Thromboplastin Time > 40 seconds

Systolic Blood Pressure > 185 mmHg

Diastolic Blood Pressure > 110 mmHg

Patient refusal

Patients with documentation of the following Reasons for Extending the Initiation of IV Thrombolytic within 270 minutes of the 1) time they were known to be at their baseline state of health; or 2) time of symptom onset:

The baseline state value set and its associated effectiveTime intend to capture the date and time prior to hospital arrival at which it was witnessed or reported that the patient was last known to be without the signs and symptoms of the current stroke or at his or her baseline state of health. The time of symptom onset value set and its associated effectiveTime is intended to capture the date and time at which symptoms started if symptom onset was witnessed. Since none of the value sets make any specific reference to stroke, their use is only meaningful in the context of stroke-specific documentation, such as a stroke assessment form or template.

In the denominator, the measure looks to identify the relationship between the Baseline State or Symptom onset and the encounter. In the numerator, the data elements are used to identify the relationship between the administration of t-PA and the time of either Baseline State or Symptom Onset. In both cases, the eCQM uses Baseline State and Time of Symptom Onset interchangeably.

The Non-elective Inpatient Encounter value set intends to capture all non-scheduled hospitalizations. This value set is a subset of the Inpatient encounter value set, excluding concepts that specifically refer to elective hospital admissions. Non-elective admissions include emergency, urgent and unplanned admissions.

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